Similarly, there are people whose degree of hemoglobin glycation is lower than average. Thus, if there is clinical reason to look for diabetes, it is reasonable to perform glucose tolerance testing even with rather low A1c levels.
Given this inherent variability in glycation, just as the 6.5% diagnostic cutoff is incorrect for many persons whose diabetes status is being ascertained, the use of a specific HbA1c goal of, say, 6.5% or 7.0%, may not be appropriate for all patients with known diabetes.
Again, assessment of actual blood glucose levels is crucial in the management of diabetes.
ZACHARY T. BLOOMGARDEN, M.D., of the Mount Sinai School of Medicine in New York, is on the speakers bureau for Merck, Novo Nordisk, and GlaxoSmithKline; serves on an advisory panel for Merck, Bristol-Myers Squibb, AstraZeneca, Boehringer Ingelheim, and Biodel; is a consultant for Merck, Novartis, Dainippon Sumitomo Pharma America, and Forest Laboratories; and is a stock shareholder of Covidien, C.R. Bard, Novartis, Roche, and Stryker Corp.
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